Objective To compare dexmedetomidine versus lidocaine for suppression of fentanyl-induced coughing during induction of general anesthesia in patients.Methods Two hundred ASA physical status Ⅰ or Ⅱ patients,aged 36-50 yr,undergoing elective gynecological operations under total intravenous anesthesia,were randomized into 2 groups (n =100 each):dexmedetomidine group (group D) and lidocaine group (group L).Dexmedetomidine 0.5 μg/kg was intravenously infused over 10 min at a rate of 0.05 μg· kg-1· min-1 starting from 20 min before induction of anesthesia in group D.Lidocaine 0.5 mg/kg was injected intravenously at 1 min before induction of anesthesia in group L.For induction of anesthesia,fentanyl was given first,and 2 min later the other drugs were given.The development and degree of coughing were recorded within 1 min after fentanyl injection.The occurrence of adverse events was recorded.Results The incidence of coughing was significantly higher and the degree of coughing was severer in group L than in group D (P ＜ 0.05).There was no signihicant difference in the incidences of hypotension and severe sinus bradycardia between groups D and L (P ＞ 0.05).Conclusion Dexmedetomidine 0.5 μg/kg injected before induction of anesthesia has better suppressive effect on fentanyl-induced coughing during induction of general anesthesia than lidocaine 0.5 mg/kg in patients.

Objective To compare the baroreflex sensitivity (BRS) when controlled hypotension was performed with sevoflurane versus isoflurane in the pediatric patients.Methods Sixty male American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 3-16 yr,with body mass index of 20-28 kg/m2,scheduled for elective scoliosis surgery under general anesthesia,were randomly divided into 2 groups (n=30 each) using a random number table:sevoflurane-induced hypotension group (group Sev) and isoflurane-induced hypotension group (group Iso).Anesthesia was induced with midazolam,sufentanil and propofol.Endotracheal intubation was facilitated with rocuronium.Anesthesia was maintained with closed-circuit low flow anesthesia with either sevoflurane or isoflurane,maintaining mean arterial pressure at 55-65 mmHg and bispectral index values at 40-60 during surgery.Cardiovascular BRS was measured before induction of anesthesia (T0),immediately after intubation (T1),immediately after the end-tidal inhalational anesthetic concentration reached 1 minimal alveolar concentration (T2),and at 10,20 and 30 min after target hypotension (mean arterial pressure 55-65 mmHg) was achieved (T3-5).Results There was no significant difference in BRS at T0-2 between the two groups (P＞0.05).Compared with the value at To,the BRS was significantly decreased at the other time points in the two groups (P＜0.05).Compared with the value at T1,the BRS was significantly increased at T2,and decreased at T3-5 in the two groups (P＜0.05).The BRS was significantly lower at T3-5 than at T2 in the two groups (P＜0.05).The BRS was significantly lower at T3-5 in group Sev than in group Iso in the two groups (P＜0.05).Conclusion Sevoflurane produces better efficacy than isoflurane when used for controlled hypotension in the pediatric patients.

Objective To investigate the therapeutic effect of modified transperitoneal laparoscopic dismembered pyeloplasty in children with with ureteropelvic junction obstruction (UPJO).Methods The clinical data of 27 children with UPJO treated with transperitoneal laparoscopic dismembered pyeloplasty were analyzed retrospectively.The age ranged from 5 to 104 months (mean,37 months).All cases were diagnosed by ultrasonography,IVU,CT and/or renal radionuclide scanning.The antero-posterior pelvic diameter was more than 3 cm by ultrasound in all cases.Indications of surgery were as followings:symptoms of upper abdominal pain or low back pain and/or split renal function ＜40％ and/or progressive dilatation.Modified transperitoneal laparoscopic dismembered pyeloplasty was performed.Double hitch stitches were transfixed at the top of pelvis and ureter to be anastomosed,and a 6 F urethral catheter was inserted as a ureteral stent percutaneously through the puncture hole and was removed 7-9 days postoperatively without double-J stent.Results All operations were completed laparoscopically without conversion to open surgery.The mean operative time was 118 min (range,85 to 176),the mean blood loss was 16 ml (range,10 to 30) and the mean postoperative hospital stay was 10.5 days (range 9 to 13).The perinephric urine drainage occurred in 2 patients with about 200 ml/d,and reduced to 6 ml/d and 4 ml/d 5 to 6 days after operation.During the follow-up period for 12 to 36 months(mean,22 months) in 27 cases,there was no stricture at UPJ and the hydronephrosis reduced significantly or disappeared.Conclusion Laparoscopic dismembered pyeloplasty with double hitch stitches and an ordinary urethral catheter as an ureteral stent is an easy method with high successful rate and less operative time,which avoids reoperation to remove the double-J stent and is worthy of clinical popularization.

Objective To evaluate the biomechanical characteristics of 4 fixation methods (single reconstruction plate,dual reconstruction plates,single cannulated screw and dual cannulated screws) in the treatment of pubic symphysis disruption.Methods Miniature spiral CT scans were performed on the complete pelvis in 5 healthy volunteers.The primary two-dimensional CT scan data at Dicom format were imported into software Mimics 15.0 for three-dimensional reconstruction of bilateral hips and sacrums.The finite element model of skeletal pelvis was obtained by grid partitioning and assignment using software Abqus 6.13.Models of pubic symphysis disruption were simulated by cutting off the unilateral sacroiliac ligament,sacral spine ligament,sacral tuberosity ligament,pubic ligament and pubic arch.Four implants(single reconstruction plate,dual reconstruction plates,single cannulated screw and dual cannulated screws) were simulated and emplaced onto the models according to standard surgical procedures.Compressive and rotational loads were implemented in all models for finite element analysis.The biomechanical properties were recorded and analyzed,including construct stiffness,micromotion of the pubic symphysis and yon Misses stress.Results Under vertical load,the space of pubic symphysis disruption ＞ 25 mm.The vertical stiffness and rotational construct stiffness of the pelvis decreased significantly from 442.738 ±29.946 N/mm and 10.118 ± 1.432 N · m/Deg in the normal group to 14.754 ±0.876 N/mm and 0.328 ±0.119 N · m/Deg,respectively.Dual reconstruction plates and dual cannulated screws displayed the best vertical tensile strength;their construct stiffness achieved 117.647 ±9.193 N/mm and 131.443 ±4.348 N/mm,respectively.Under anti-rotation load,dual cannulated screws displayed the best performance because they rebuilt 68.6％ of the whole structural stiffness.For the local stability of the pubic symphysis,dual reconstruction plates showed a strong local anti-rotation capability and dual cannulated screws a good local anti-tensile capability.The displacement in the dual cannulated screws group was only-0.240 ±0.119 mm under vertical load while the angular displacement in the dual reconstruction plates group only 0.218°±0.182°.Single reconstruction plate endured the maximum yon Misses stress which was obviously concentrated.Conclusion Dual cannulated screws may have biomechanical advantages for treatment of pubic symphysis disruption.

Objective To investigate the application of 3D printing technique in the treatment of obsolete pelvic and acetabular fractures.Methods The clinical data of 23 patients with obsolete pelvic and acetabular fractures were retrospectively analyzed who had been surgically treated in our hospital from January 2006 through January 2016.3D printing technique was used in surgical planning in 11 of them,including 8 males and 3 females,with an average age of 33.8 ±4.9 years (3D group).The other 12 patients received conventional surgery without using 3D printing technique.They were 9 males and 3 females,with an average age of 34.8 ± 8.3 years (conventional group).The primary pelvic fractures in both groups were all type C according to the Tile classification system.The patients complicated with acetabular fracture in the 3D group and the conventional group were 10 and 11 cases respectively.The operative time,blood loss,blood transfusion.intraoperative fluoroscopy,visual analogue score (VAS) and Majeed score were compared between the 2 groups.Results The 2 groups were compatible in terms of preoperative general data (P ＞ 0.05).For the 3D group and the conventional group,operative time was 166.4± 24.2 min versus 222.5 ± 49.0 min.blood loss 2,063.6 ± 484.3 mL versus 2,700.0 ± 597.0 mL,blood transfusion 13.2 ± 3.2 U versus 17.6 ± 4.5 U,and intraoperative fluoroscopy 7.4 ± 1.3 times versus 11.7 ± 3.6 times.There were significant differences between the 2 groups in the above indexes (P ＜ 0.05).The 3D group and the conventional group obtained an average follow-up of 18.4 months and 21.7 months,respectively.The postoperative VAS scores were respectively 1.8 ±-0.9 points and 3.4 ± 1.0 points for the 2 groups,showing a significant between-group difference (P ＜0.05).The Majeed scores at the last follow-ups were respectively 85.7 ± 4.2 points and 84.9 ± 3.1 points for the 2 groups,showing no significant between-group difference (P ＞ 0.05).There were no such complications in the 3D group as iatrogenic nerve injury,vascular injury,nonunion or internal fixation failure.One patient in the conventional group suffered transient iatrogenic injury to the sciatic nerve.Conclusions 3D printing technique can provide helpful guidance for diagnosis and fracture classification preoperatively.It improves the patient's perioperative safety by benefiting intraoperative reduction,shortening operative time,and reducing intraoperative blood loss and intraoperative fluoroscopy.

Objective To investigate the association between DNA methyltransferase 3B(DNM T3B) promoter single nucleotide polymorphism(SNP) with susceptibility to gastric cancer (GC) in Han population of Suqian region .Methods A total of 233 pa-tients with gastric cancer were recruited into the study group ,208 healthy persons were recruited in the control group .Genomic DNA was extracted from peripheral blood ,and the frequency distribution of -579G> T locus in DNMT3B promoter region was de-tected by polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP) .Results The distribution of TT genotypes compared with GT +GG in all the two groups were significantly different (χ2 =6 .517 ,P<0 .05) .When stratified by age , there was significant difference between TT and GT + GG genotypes at the age range ≥60 years(χ2 = 4 .728 ,P< 0 .05) .When stratified by gender ,there was no significant difference between different gender groups (χ2 = 3 .541 ,P> 0 .05 ;χ2 = 3 .676 ,P>0 .05) .Conclusion The DNMT3B -579G> T is associated with the genetic susceptibility of gastric cancer .It might be a risk fac-tor of gastric cancer .

It is the intent of this investigation to gain an insight into the relationship of serum total adiponectin with polycystic ovary syndrome (PCOS) and insulin resistance. Fifty-eight PCOS patients were enrolled (29 with high serum insulin level and 29 without), at the same time, 29 non-PCOS women with normal weight were included as control. The influencing factors of total adiponectin, PCOS and insulin resistance were analyzed. The serum total adiponectin of PCOS patients and all participants were found to be negatively related to waist hip ratio (r = -0.39, r = -0.36) and InHOMA-IR (r = -0.53, r = -0.45), respectively. Adiponectin was not a protective factor of PCOS (P > 0.1), but it was that of PCOS-insulin resistance (OR = 0.81; 95% CI: 0.67-0.97; P = 0.02). LH/FSH (OR = 1.51; 95% CI: 1.16-1.96; P = 0.01) and InHOMA-IR (OR = 1.26; 95% CI: 1.10-1.44; P = 0.01) were risk factors of PCOS, and waist hip ratio was that of PCOS-insulin resistance (OR = 8.57; 95% CI, 2.14-34.30, P = 0.01). Adiponectin might influence fasting insulin and InHOMA-IR (B = -0.22, P = 0.001; B = -0.02, P = 0.002). These data signify that adiponectin is not directly related with PCOS, but it is related with PCOS-HL Adiponectin might participate in the pathophysiologic mechanism of PCOS by influencing insulin sensitivity.
Adiponectin ; blood ; Adult ; Female ; Humans ; Insulin Resistance ; physiology ; Polycystic Ovary Syndrome ; blood ; physiopathology ; Waist-Hip Ratio ; Young Adult

This paper is aimed to analyze the correlation between serum free testosterone (FT) and total testosterone (TT) to acquire a cutoff about using total testosterone to diagnose hyperandrogenism in Chengdu females. We investigated 1854 women by cluster sampling method, detected their serum FT levels and TT levels, scored relative items, analyzed the correlation and made the ROC curve to get a cutoff of TT levels. Serum FT had a linear correlation with serum TT (r = 0.597, r2 = 0.356, P < 0.001). The cutoff value was 0.635 ng/mL. The specificity and sensitivity were 76.3% and 77.24%, respectively. No correlation found between serum FT and Ferriman-Gallway Score (P = 0.392). Positive correlations were seen between serum FT and Plewig-Kligman Score (r = 0.137, P < 0.001), serum TT and Ferriman-Gallway Score (r = 0.069, P = 0.003) and serum TT and Plewig-Kligman Score (r = 0.092, P < 0.001). There is a linear correlation between serum FT and TT. We can diagnose hyperandrogenism according to the serum TT cutoff value (0.635 ng/mL). Its clinical symptoms are not paralleled with the biochemical test results.
Adolescent ; Adult ; Child ; China ; Female ; Humans ; Hyperandrogenism ; blood ; Middle Aged ; Reference Values ; Sampling Studies ; Testosterone ; blood ; Young Adult

Objective To explore the application value of external fixator in obsolete hip dislocation.Methods Retrospective analysis of 9 cases of obsolete hip dislocation treated with external fixator from January 2010 to January 2017.There were 6 males and 3 females,with an average of 32.0±8.3 years old (range 19-47).The time from injury to operation was 3-9 months,with an average of 6.2± 1.9 months.The patient's limb shortening length,traction time,traction length,operation time,surgical bleeding volume,preoperative and last follow-up VAS score,Epstein score,D'Aubigne functional score were recorded.Results The length of the limb shortened 5-11cm,with an average of 6.7±2.0 cm.The preoperative traction time ranged 20-45 d,with an average of 26.9±8.2 d.The length of traction ranged 5-12 cm,with an average of 7.1±2.2 cm.The second reconstruction operation time was 2.0-4.0 hours,with an average of 2.8±0.7 h.The bleeding volume was 800-2 000ml,with an average of 1 216.7±422.8 ml.The Epstein score at the last follow-up was excellent in 4 cases,good in 4 cases and improved in 1 case.The preoperative VAS score and the final follow-up VAS score were 0.9±0.8 points and 4.6±0.9 points respectively.There was a significant difference between preoperative and postoperative VAS scores (t=8.981,P=0.000).The D'Aubigne functional scores of preoperative and final follow-up were 5.2±1.0 points and 13.1±2.0 points respectively and the difference was statistically significant (t=-12.044,P=0.000).Conclusion The external fixation in the treatment of obsolete dislocation of the hip is helpful and accepted in patients with femoral head dislocation.It is easy to carry and tract for patients and convenient for functional exercise.The external fixation makes operation simple and flexible;the traction force is strong and the effect of the femoral head reduction is obvious,the operation method is simplified and the quality of the reduction is improved.

Objective To evaluate clinical outcomes of the Kocher-Langenbeck (K-L) approach combined with partial proximal Watson-Jones incision for the treatment of acetabular fractures involving the weight-bearing area.Methods From January 2012 to January 2017,20 patients were treated by the K-L approach combined with partial proximal Watson-Jones incision for acetabular fracture involving the weight-bearing acetabular dome.They were 13 males and 7 females,with an average age of 40.7 years (range,from 22 to 67 years).According to the Letournel-Judet classification,there were 8 posterior wall fractures,one transverse fracture,one T-shaped fracture,one transverse and posterior wall fracture,3 posterior column and posterior wall fractures,and 6 double-column fractures.All patients received open reduction and internal fixation with plates and screws.The outcomes of reduction were evaluated at follow-ups according to the Matta criteria.The hip function was evaluated according to the modified Merle d'Aubigne-Postel criteria and the abductor strength by the American Medical Research Council criteria at final follow-ups.Results All the 20 patients were followed up for an average of 8.2 months (range,from 7 to 21 months).They all obtained bony union after 10 to 18 weeks (average,11.4 weeks).No fracture displacement,internal fixation loosening or deep infection occurred.According to the Matta criteria,anatomic reduction was achieved in 13 cases,satisfactory reduction in 6 cases,and unsatisfactory in one (a satisfactory rate of 95％).The modified Merle d'Aubigne-Postel scoring for the hip function at the final follow-ups yielded 9 excellent cases,7 good cases,3 fair cases and one poor case (an excellent to good rate of 80％).Ectopic ossification of Brooker grade Ⅰ occurred in one case.The abductor strength was rated as grade Ⅳ in 3 cases and as grade Ⅴ in 17.Conclusions In the treatment of acetabular fractures involving the acetabular dome,the K-L approach combined with partial proximal Watson-Jones incision can increase the operation view of the weight-bearing area,enhance the anatomic matching of femoral head and acetabular roof,and reduce the difficulties in reduction and fixation.